URTI + PNA ** Flashcards
Sinusitis vs rhinosinusitis
Sinusitis: inflammation of 1 or more paranasal sinuses
Rhinosinusitis: inflammation of nasal mucosa + sinuses
RF for sinusitis
CF, immunodeficiency, irritants, deviated septum, polyps, cocaine use, trauma
Acute vs chronic vs ped causes of sinusitis
Acute causes: s pneumonia, H influenza
Chronic causes: S aureus, pseudomonas, enterobacteriaceae
Child causes: moraxella catarrhalis
Sx + complications of sinusitis
Sx: persistent URTI sx, no improvement in 10d
PODS: facial PAIN, nasal OBSTRUCTION, nasal DISCHARGE, SMELL disorder
Complications: periorbital cellulitis, meningitis, intracranial abscess, sepsis
Preseptal Cellulitis
Postseptal Cellulitis
Abscess (Sinus, Orbital, Subperiosteal, Brain)
Meningitis
Cavernous Sinus Thrombosis
Osteomyelitis
Rx for:
Acute mild/ mod
Severe
Chronic w/o nasal polyps
Chronic w/ nasal polyps
Acute mild/ mod: intranasal steroids, abx if no improvement
Severe: intranasal steroid + amoxicillin
Chronic w/o nasal polyps: intranasal steroids
Chronic w/ nasal polyps: intranasal steroids + oral steroids + amox/clav x3w
Sx + complications of EBV
Complications: airway obstruction with large tonsils, encephalitis, myocarditis, splenic rupture, lymphoma
Sx: fatigue, sore throat, fever, nausea, anorexia, cough, photophobia, lymphadenopathy
Ix + Rx EBV
Ix: EBV serology, ESR
Rx: consider steroids if impending airway obstruction, off sports x3w
Sx of EBV
Sx: erythema, edema of pharynx, tonsillar exudate, lymphadenopathy, scarlet fever (sandpaper rash), strawberry tongue
FeverPAIN criteria
FeverPAIN criteria: temp >38, tonsillar exudate, severely inflamed tonsils, absence of cough
2-3 = FU or delayed script
4 = abx
Ix, rx + when to refer for surgery for pharyngitis
Ix: throat culture or rapid antigen test
Rx: Pen V 300mg TID or amoxicillin 500mg BID
Refer for tonsillectomy: >7/yr, >5 in 2yr, >3 in 3yr
How to manage high risk groups
Flu + pneumococcal vaccine
Treat early with oseltamivir phosphate, amantadine
qSOFA score
RR >22, altered MS, systolic BP <100
DDx for PNA
PJP, TB, Mycobacterium avium complex, influenza, toxoplasmosis
What abx partially treat TB?
Fluoroquinolones
Dx of PJP
bronchoscopy